1. Neonatal Jaundice
Carrie Phillipi, MD, PhD

2. Newborn with Jaundice

3. Neonatal Jaundice Definitions
Physiologic
Pathologic
Indirect (unconjugated)
Direct (conjugated)
Breast feeding jaundice
Breast milk jaundice

4. Production of Bilirubin

5. Conjugation of Bilirubin

6. Problems at the level of the RBC
Hemolysis (ABO, Rh, minor antigens)
Hemolysis (Enzyme Deficits--G6PD deficiency)
Bruising
Cephalohematoma
Increased Load (polycytemia)
Membrane Defects

7. Direct and Indirect Coombs

8. Problems at the level of the LIVER
Sluggish enzyme (UGT 1A1)
Crigler-Najjar (rare)
Gilbert’s (rare)
Direct hyperbilirubinemia (always pathologic)

9. Problems at the level of the GUT
Poor feeding
Obstruction
Infant of a diabetic mother
The entero-hepatic circulation kicks in!

10. Generic Problems
Prematurity
Serious Infections
Sepsis
Hypoalbuminemia

11. Jaundice on at 96 hours
A term baby is noted to be jaundiced to the hips at 96 hours of life. Mother is AB+/Ab-, her milk is in and baby is feeding well with transitional stools.
What is your next step?

12. Hyperbilirubinemia—risk stratification

13. Risk factors for jaundice
Exclusive Breastfeeding
Risk factors for jaundice
Jaundice in the first 24 hours
East Asian Race
Cehalohematoma
Blood Group Incompatibility or known
Hemolytic Disease (G6PD deficiency)
Bruising
Previous sibling who
received phototherapy

14. Guidelines for Phototherapy

15. Kernicterus

16. Jaundice at 12 hours
A term baby born by SVD with apgars of 8,9 is noted to have jaundice to the chest at 12 hours of life. Mother is O+/Ab-. Baby is vigorous and well-appearing.
What is your next step?

17. Phototherapy

18. Transcutaneous Bilirubinometer

19. Jaundice at 72 hours
Well-appearing near term (37 week) infant born to O+/Ab- mother is noted to be jaundiced to the hips at 72 hours.
What is your next step?